Application Cover Sheet s5

OFFICIAL ENTRY FORM

HOW TO SUBMIT YOUR CONTEST ENTRY

 Complete the entry form (this document) in its entirety.  Save the document.  Visit http://goo.gl/yzT4UI  Upload this file using the upload form at the bottom of the web page.  You will receive an email confirmation of the upload.  NOTE: Only files with a .doc, .docx or .rtf format are accepted. PRIMARY CONTACT PERSON Provide contact information for the primary point person for the contest entry.

First Name ______Last Name ______Title ______Email ______Phone ______

COMPANY INFORMATION Provide contact information for your business (if you have formed a company). A company not having yet been formed will not be a detriment to your application.

Company Name ______Website ______Address1 ______Address2 ______City/State/Zip ______County ______Phone (main) ______Number of employees ______Incorporation type ______Year founded ______Industry sector ______

How did you hear about this contest?

If you win, how do you plan to spend the cash prize and utilize the prize package?

BEN FRANKLIN TECHNOLOGY PARTNERS Page 2 of 9 2016 Ben Franklin Big Idea Contest Entry Form PRODUCT DEVELOPMENT/COMMERCIALIZATION PLAN This is the most important section of the entry form. Each form field has a maximum length of 800 characters, so be succinct and specific.

Before beginning, review the sample completed entry form Included at the end of this document.

DO NOT SUBMIT ANY CONFIDENTIAL INFORMATION

Market Opportunity:

Description of Technology/Product:

Customers and Customer Problem:

Value Proposition:

Intellectual Property:

Competitive Advantage and Competitors:

Team/Management:

New Product Financing:

Economic Development:

BEN FRANKLIN TECHNOLOGY PARTNERS Page 3 of 9 2016 Ben Franklin Big Idea Contest Entry Form FINANCIAL INFORMATION

Capital Raised $ Total funds raised to date, determined by adding Debt and Equity totals.

Debt $ Debt may be bank debt, economic development debt or a combination

Equity $ Equity includes founders’ contributions.

Capital Available $ Funds still available from fundraising above.

Monthly Cash Flow $ How much money you are spending each month (known as burn rate). Should be entered as a negative number.

Capital Being Sought $ Total new funds being sought from all sources, including the $35,000 prize from this contest.

Debt $ Debt may be bank debt, economic development debt or a combination

Equity $ Equity includes founders’ contributions.

Financials 2012 2013 2014 2015* 2016* 2017* 2018*

Revenues $ $ $ $ $ $ $

Cost of goods sold $ $ $ $ $ $ $

Gross Profit $ $ $ $ $ $ $

SG&A $ $ $ $ $ $ $

Net Income $ $ $ $ $ $ $

* Projected Historical Information: Include up to 3 years’ historic results, if available; current year to date; then 3 years’ projected financial information.

SG&A: Sales, General and Administrative expenses; should include interest, taxes, depreciation and amortization expenses.

Net Income: Net of all expenses, including ITDA.

BEN FRANKLIN TECHNOLOGY PARTNERS Page 4 of 9 2016 Ben Franklin Big Idea Contest Entry Form Following is a sample completed entry form, along with clarifications of the different data fields.

BEN FRANKLIN TECHNOLOGY PARTNERS Page 5 of 9 2016 Ben Franklin Big Idea Contest Entry Form PRIMARY CONTACT PERSON Provide contact information for the primary point person for the contest entry.

First Name John Last Name Doe Title Marketing Director Email [email protected] Phone (717) 555-5555

COMPANY INFORMATION Provide contact information for your business (if you have formed a company). A company not having yet been formed will not be a detriment to your application.

Company Name Autodyne, LLC Website www.autodyne.net Address1 1122 Boulevard Way Address2 Suite 100 City/State/Zip State College, PA 16803 County Centre Phone (main) (814) 555-5555 Number of employees 13 Incorporation type S-corp Year founded 2007 Industry sector Automotive Technology

How did you hear about this contest? I saw a poster in the Small Business Development Center at XYZ University.

If you win, how do you plan to spend the cash prize and utilize the prize package? We will use the cash prize for patent and legal fees, and the $100,000 loan for marketing and trade show expenses for the new product. The other prizes will be used for final manufacturability work.

BEN FRANKLIN TECHNOLOGY PARTNERS Page 6 of 9 2016 Ben Franklin Big Idea Contest Entry Form CONTEST APPLICATION INSTRUCTIONS

Use the following guidance to help you complete the 9 contest questions.

1. Market Opportunity:

Identify the market sectors that you are targeting with your technology. What is the size of the total market, as well as the portion of it you can reasonably address with your innovation? What level of sales in five years do you expect your innovation to reach? What percentage of total sales will that comprise?

2. Description of your technology/product:

Provide up to three sentences briefly describing your technology or product. (Consider this the elevator pitch for your innovation.)

Describe the general steps yet required to bring your innovation to the marketplace.

3. Customers and Customer Problem:

Describe who might purchase what you have developed. How large is each sector you have identified, both in terms of numbers of companies and in the volume they might purchase?

What problems are the customers you’ve identified above having, that your product or innovation can solve? How big is this problem, in terms of productivity losses, maintenance costs, materials costs, etc?

4. Value Proposition:

Why would a customer, whom you’ve identified above, purchase your solution, rather than purchasing someone else’s solution or doing nothing?

5. Intellectual Property:

Do you have, or are you in process of, patent filings? If filed, are they provisional or full patent applications? What is their status with the US Patent and Trademark Office? Do you have other forms of IP to keep competitors at bay?

BEN FRANKLIN TECHNOLOGY PARTNERS Page 7 of 9 2016 Ben Franklin Big Idea Contest Entry Form 6. Competitive Advantage and Competitors:

Describe the competitive landscape and list your competitors. This should include not only solutions that are similar to yours, but also those that are quite different, but are being used by your identified customer base to solve the problem you’ve identified.

Describe how and why your innovation is superior to solutions currently being deployed by the customers you’ve identified, not only in your mind, but in theirs.

7. Team/ Management:

List the senior team members with a 1 paragraph each description of their relevant background. This should include technical, sales and business management. How will their participation in the rollout of this new product affect the execution of their current company responsibilities?

8. New Product Financing

All new products requiring funding to pay for R&D, production equipment, additional labor and new marketing strategies, to name a few. Describe how you will fund this new product, whether through bank financing, equity investment, cash flow, whether or not these funding streams are already in place.

9. Economic Development

Describe how you will maintain a significant presence in Pennsylvania over the next 5 years. Include employment estimates, if possible.

BEN FRANKLIN TECHNOLOGY PARTNERS Page 8 of 9 2016 Ben Franklin Big Idea Contest Entry Form FINANCIAL INFORMATION

Capital Raised $ 350,000 Total funds raised to date, determined by adding Debt and Equity totals.

Debt $ 200,000 Debt may be bank debt, economic development debt or a combination

Equity $ 150,000 Equity includes founders' contributions.

Capital Available $ 65,000 Funds still available from fundraising above.

Monthly Cash Flow $ (10,750) How much money you are spending each month (known as burn rate). Should be entered as a negative number.

Capital Being Sought $ 500,000 Total new funds being sought from all sources, including the $35,000 prize from this contest.

Debt $ 100,000 Debt may be bank debt, economic development debt or a combination

Equity $ 400,000 Equity includes founders' contributions.

Financials 2012 2013 2014 2015* 2016* 2017* 2018*

Revenues $310,768 $621,736 $929,331 $206,308 $3,053,900 $6,205,897 $9,687,901

Cost of goods sold $340,879 $680,123 $1,061,228 $101,208 $1,092,765 $1,951,131 $2,067,981

Gross Profit $(30,111) $(58,387) $(131,897) $105,100 $1,961,135 $4,254,766 $7,619,920

SG&A $62,176 $90,546 $185,870 $15,870 $1,210,907 $3,215,673 $5,224,098

Net Income $(92,287) $(148,933) $(317,767) $89,230 $750,228 $1,039,093 $2,395,822

* Projected

BEN FRANKLIN TECHNOLOGY PARTNERS Page 9 of 9 2016 Ben Franklin Big Idea Contest Entry Form